Apr 24, 2019

Class Action Addresses Defective EOBs

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Brian S. King
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The U.S. District Court for the Western District of Pennsylvania has recently approved settlement of a class action against Highmark, a Blue Cross and Blue Shield association member. The case asserts that the insurer systematically failed to comply with the requirements of ERISA’s claims procedure regulation as to the information required to be sent to insureds when their claims are denied. Specifically, the insurer failed to provide the specific reason claims were denied and failed to specify where in the insurance policy the language on which the claim denial was based could be found. You can read more about the class action at this website set up to provide information to class members. I’ve blogged before about the lack of compliance by insurers in the information contained in their EOBs. In my experience, most health insurers fail to satisfy the requirements of the ERISA claims procedure regulation in their EOB information. Thanks to Robin Fisk for her sharp eye in picking this case up.

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